Published online Nov 27, 2014. doi: 10.5411/wji.v4.i3.194
Revised: October 12, 2014
Accepted: October 28, 2014
Published online: November 27, 2014
Liver disease has recently been described as an important cause of morbidity and mortality in patients infected with human immunodeficiency virus (HIV). Liver test changes are useful surrogates of the burden of liver disease. Previous studies have shown that transaminase elevations are frequent among these patients. The cause of those changes is harder to establish in HIV-patients. We present a 61-year-old caucasian male, diagnosed with HIV type 1 infection since 1998, under highly active antiretroviral treatment (HAART), with virological suppression and immunological recovery. He presented in a follow-up laboratory workup high values of transaminases, arthralgia at the hip joints and hepatomegaly. Liver function tests were normal. The antibodies to hepatitis viruses were negative. However, autoimmune study and liver biopsy were compatible with autoimmune hepatitis (AIH). The AIH is a rare diagnosis in HIV-infected patients perhaps because the elevation of transaminases and changes in liver function tests are often associated to HAART or to other possible liver diseases, namely viral hepatitis and non-alcoholic steatohepatitis. The diagnosis may be underestimated. There are no specific recommendations available for the treatment of HIV-associated AIH although the immunosupression with slower tapering seems the most reasonable approach.
Core tip: Autoimmune hepatitis diagnosis is a rare diagnosis in human immunodeficiency virus (HIV)-infected patients perhaps because the elevation of transaminases and changes in liver function tests are often attributed to the Highly Active Antiretroviral Treatment or to other possible liver diseases, namely viral hepatitis and Non-Alcoholic Steatohepatitis. The diagnosis may be underestimated. There is no established treatment in those patients but it seems reasonable to consider immunosuppression also in HIV-infected patients.